COURSE CODE: VATI RN Maternal Newborn EXAM TIME
COURSE TITLE: Maternal Newborn Nursing — Comprehensive DATE ALLOWED
Assessment —/—/ 120
INSTRUCTOR: — —— Minutes
◇
VATI RN Maternal
Newborn
Comprehensive Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (100 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. A charge nurse is teaching about substance use disorders during pregnancy. Which
statement by a staff nurse indicates an understanding of the teaching?
A. "Methadone is contraindicated during pregnancy and breastfeeding."
B. "Methadone is safe during pregnancy and breastfeeding."
C. "Cocaine use in the first trimester is not associated with adverse outcomes."
D. "Opioid withdrawal in the newborn does not require medication."
✦ CORRECT ANSWER: B — "Methadone is safe during pregnancy and breastfeeding."
Methadone and buprenorphine are the standard-of-care treatments for opioid use disorder during pregnancy, as
they prevent withdrawal-related fetal distress, reduce illicit drug use, and improve prenatal care adherence. Both
are compatible with breastfeeding because minimal amounts are transferred to breast milk. Abrupt opioid
discontinuation is dangerous and may precipitate preterm labour or fetal demise. Cocaine use in the first trimester
increases miscarriage risk; use in later pregnancy increases placental abruption risk. Newborns exposed to opioids
in utero often require pharmacologic treatment for neonatal abstinence syndrome.
,2. A nurse is caring for a client who received terbutaline subcutaneously. Which finding
indicates the medication was effective?
A. Increased frequency of contractions
B. Decreased frequency of contractions
C. Maternal heart rate of 68 bpm
D. Cervical dilation of 4 cm
✦ CORRECT ANSWER: B — Decreased frequency of contractions.
Terbutaline is a beta-adrenergic agonist that relaxes uterine smooth muscle by stimulating beta-2 receptors,
thereby inhibiting uterine activity. Effectiveness is demonstrated by a reduction in contraction frequency, intensity,
and duration — the goal of tocolytic therapy. It is now used primarily as an acute short-term intervention (typically
≤48 hours) to allow time for corticosteroid administration for fetal lung maturity, as ongoing maintenance tocolysis
has not shown improved outcomes and carries maternal cardiac risks.
3. A nurse is reinforcing teaching about situations requiring an amniotomy. Which action
should be included in the teaching?
A. Placement of an external tocodynamometer
B. Placement of a fetal scalp electrode
C. Administration of an oral tocolytic
D. Performance of a nonstress test
✦ CORRECT ANSWER: B — Placement of a fetal scalp electrode requires ruptured membranes.
A fetal scalp electrode provides direct, continuous internal monitoring of the fetal heart rate but requires ruptured
membranes and adequate cervical dilation. The electrode is attached to the fetal presenting part (scalp or
buttocks), so amniotic membranes must be absent for placement. Following amniotomy, the nurse monitors FHR
for variable or late decelerations (potential cord compression), documents amniotic fluid characteristics (colour,
odour, consistency), obtains maternal temperature every 2 hours to monitor for chorioamnionitis, and limits
maternal activity to reduce infection risk.
, 4. A nurse is reviewing the plan of care for a client with preeclampsia who has a prescription
for labetalol. Which finding indicates the nurse should withhold the medication?
A. Heart rate 54/min
B. Blood pressure 152/94 mmHg
C. Respiratory rate 18/min
D. Temperature 37.0°C
✦ CORRECT ANSWER: A — Heart rate 54/min.
Labetalol is a combined alpha- and beta-adrenergic blocker. A heart rate of 54 bpm indicates bradycardia, and
administering a beta-blocker would further reduce heart rate, potentially causing symptomatic bradycardia,
reduced cardiac output, and decreased uteroplacental perfusion. Standard parameters for withholding labetalol
include heart rate below 60 bpm. The nurse should assess the client, withhold the medication, and notify the
provider. Blood pressure of 152/94 mmHg is elevated and supports the need for the antihypertensive.
5. A client who is 30 weeks of gestation begins choking while eating lunch and is unable to
speak or cough. Identify the sequence of steps the nurse should take to clear the airway
obstruction.
A. Initiate abdominal thrusts, then chest thrusts, then CPR.
B. Stand posterior to the client, position arms under the axilla across the chest, place thumb-side of a
clenched fist to the mid-sternum, and initiate chest thrusts using a backward motion.
C. Call for help, then perform abdominal thrusts immediately.
D. Encourage the client to drink water to dislodge the obstruction.
✦ CORRECT ANSWER: B — Stand posterior, position arms under axillae across chest, place clenched fist at
mid-sternum, initiate backward chest thrusts.
In a pregnant client past the first trimester, chest thrusts replace abdominal thrusts (Heimlich manoeuvre) because
the gravid uterus makes abdominal thrusts ineffective and may cause injury. The nurse stands behind the client,
wraps arms under the axillae and across the chest, places the thumb-side of a clenched fist at the mid-sternum
(avoiding the xiphoid process), and delivers firm backward thrusts. If the client loses consciousness, CPR is initiated
with manual left uterine displacement to relieve aortocaval compression, and emergency services are activated.
COURSE TITLE: Maternal Newborn Nursing — Comprehensive DATE ALLOWED
Assessment —/—/ 120
INSTRUCTOR: — —— Minutes
◇
VATI RN Maternal
Newborn
Comprehensive Assessment Examination
ALL QUESTIONS ARE COMPULSORY
A MULTIPLE CHOICE QUESTIONS (100 Marks)
Choose the single best answer for each question unless "Select All That Apply" is indicated. Write the correct letter(s) in the
space provided.
1. A charge nurse is teaching about substance use disorders during pregnancy. Which
statement by a staff nurse indicates an understanding of the teaching?
A. "Methadone is contraindicated during pregnancy and breastfeeding."
B. "Methadone is safe during pregnancy and breastfeeding."
C. "Cocaine use in the first trimester is not associated with adverse outcomes."
D. "Opioid withdrawal in the newborn does not require medication."
✦ CORRECT ANSWER: B — "Methadone is safe during pregnancy and breastfeeding."
Methadone and buprenorphine are the standard-of-care treatments for opioid use disorder during pregnancy, as
they prevent withdrawal-related fetal distress, reduce illicit drug use, and improve prenatal care adherence. Both
are compatible with breastfeeding because minimal amounts are transferred to breast milk. Abrupt opioid
discontinuation is dangerous and may precipitate preterm labour or fetal demise. Cocaine use in the first trimester
increases miscarriage risk; use in later pregnancy increases placental abruption risk. Newborns exposed to opioids
in utero often require pharmacologic treatment for neonatal abstinence syndrome.
,2. A nurse is caring for a client who received terbutaline subcutaneously. Which finding
indicates the medication was effective?
A. Increased frequency of contractions
B. Decreased frequency of contractions
C. Maternal heart rate of 68 bpm
D. Cervical dilation of 4 cm
✦ CORRECT ANSWER: B — Decreased frequency of contractions.
Terbutaline is a beta-adrenergic agonist that relaxes uterine smooth muscle by stimulating beta-2 receptors,
thereby inhibiting uterine activity. Effectiveness is demonstrated by a reduction in contraction frequency, intensity,
and duration — the goal of tocolytic therapy. It is now used primarily as an acute short-term intervention (typically
≤48 hours) to allow time for corticosteroid administration for fetal lung maturity, as ongoing maintenance tocolysis
has not shown improved outcomes and carries maternal cardiac risks.
3. A nurse is reinforcing teaching about situations requiring an amniotomy. Which action
should be included in the teaching?
A. Placement of an external tocodynamometer
B. Placement of a fetal scalp electrode
C. Administration of an oral tocolytic
D. Performance of a nonstress test
✦ CORRECT ANSWER: B — Placement of a fetal scalp electrode requires ruptured membranes.
A fetal scalp electrode provides direct, continuous internal monitoring of the fetal heart rate but requires ruptured
membranes and adequate cervical dilation. The electrode is attached to the fetal presenting part (scalp or
buttocks), so amniotic membranes must be absent for placement. Following amniotomy, the nurse monitors FHR
for variable or late decelerations (potential cord compression), documents amniotic fluid characteristics (colour,
odour, consistency), obtains maternal temperature every 2 hours to monitor for chorioamnionitis, and limits
maternal activity to reduce infection risk.
, 4. A nurse is reviewing the plan of care for a client with preeclampsia who has a prescription
for labetalol. Which finding indicates the nurse should withhold the medication?
A. Heart rate 54/min
B. Blood pressure 152/94 mmHg
C. Respiratory rate 18/min
D. Temperature 37.0°C
✦ CORRECT ANSWER: A — Heart rate 54/min.
Labetalol is a combined alpha- and beta-adrenergic blocker. A heart rate of 54 bpm indicates bradycardia, and
administering a beta-blocker would further reduce heart rate, potentially causing symptomatic bradycardia,
reduced cardiac output, and decreased uteroplacental perfusion. Standard parameters for withholding labetalol
include heart rate below 60 bpm. The nurse should assess the client, withhold the medication, and notify the
provider. Blood pressure of 152/94 mmHg is elevated and supports the need for the antihypertensive.
5. A client who is 30 weeks of gestation begins choking while eating lunch and is unable to
speak or cough. Identify the sequence of steps the nurse should take to clear the airway
obstruction.
A. Initiate abdominal thrusts, then chest thrusts, then CPR.
B. Stand posterior to the client, position arms under the axilla across the chest, place thumb-side of a
clenched fist to the mid-sternum, and initiate chest thrusts using a backward motion.
C. Call for help, then perform abdominal thrusts immediately.
D. Encourage the client to drink water to dislodge the obstruction.
✦ CORRECT ANSWER: B — Stand posterior, position arms under axillae across chest, place clenched fist at
mid-sternum, initiate backward chest thrusts.
In a pregnant client past the first trimester, chest thrusts replace abdominal thrusts (Heimlich manoeuvre) because
the gravid uterus makes abdominal thrusts ineffective and may cause injury. The nurse stands behind the client,
wraps arms under the axillae and across the chest, places the thumb-side of a clenched fist at the mid-sternum
(avoiding the xiphoid process), and delivers firm backward thrusts. If the client loses consciousness, CPR is initiated
with manual left uterine displacement to relieve aortocaval compression, and emergency services are activated.
